Lecture 7 -Lymphatic System Flashcards

1
Q

What does the lymphatic system comprise of?

A

Lymph vessels, lymphatic organs and diffuse lymphatic tissue

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2
Q

What are the three general functions and features of lymph vessels

A
  1. Collection of tissue fluid and return to systemic circulation
  2. Transport of lymphocytes and other cells
  3. Uptake and transport of long chain fatty acids absorbed in intestine
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3
Q

What is the composition of tissue fluid/plasma (3)

A

Water, proteins, lipids extruded from blood capillaries into connective tissue matrix

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4
Q

How is 20% of tissue fluid returned to main systemic circulation

A

Lymph vessels

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5
Q

What happens to the other 80% of tissue fluid not returned

A

Removed via blood capillaries and perspiration

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6
Q

What is lymphoedema

A

Compromised fluid or protein return

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7
Q

Where is the majority of lymph returned to the venous system

A
  1. Junction of subclavian and internal jugular veins (usual)

2. Additional: IVC, renal and suprarenal, azygous and iliac veins but also lymph nodes

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8
Q

Where are lymphocytes produced

A

Lymph nodes along the course of larger lymph vessels and by other lymphatic organs and tissue such as spleen and gut associated lymphatic tissue (GALT)

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9
Q

How long do FAs havae to be to be absorbed by intestinal epithelial cells and transported into extracellular space + lymph vessels of intestinal villi

A

more than 12 carbon atoms

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10
Q

Where is lymph transported to from lymph vessels of intestinal villi /lacteals

A

Thoracic duct and ultimately blood stream

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11
Q

Where do smaller fatty acids less than 12 carbons go

A

Taken into blood stream and then portal vein and liver

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12
Q

What are lymph capillaries?

A

Blindly ending tubes in connective tissue which are initially a plexus which anastamose to form larger vessels

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13
Q

Which lymph vessel is the larger and what is its diameter

A

Throacic duct

2-5mm in diameter

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14
Q

Lymph vessels have thick walls

A

False

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15
Q

What are characteristics of lymph fluid return

A

Gravity
Pressure from adjacent organs
Viscera
Valves

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16
Q

Larger lymph vessels have their own blood supply of small vessels forming a plexus true or false

A

True

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17
Q

Lymph vessels do not repair after damage

A

False, repair is rapid especially in smaller vessels

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18
Q

Lymph vessels do not follow large blood vessels true or false

A

False, often follow large blood vessels as a plexus on adventitia

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19
Q

Lymph vessels are difficult to recognise in classical divisions, how are they usually sutdied

A

Dyes, coloured latex or radioopaque material (lipidol) in conjunction with x-rays

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20
Q

Lymph vessels are not found in: (3)

A

CNS
Bone marrow
Avascular tissue - cornea, epidermis, cartilage

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21
Q

Lymph vessels are often associated with?

A

Lymph nodes

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22
Q

What is a general length of lymph organs/nodes

A

1-25mm

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23
Q

What do lymph nodes contain

A

Proliferative structures - lymph nodules

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24
Q

What do lymph nodules produce

A

Lymphocytes, other cells of the immune system which are involved in immunosurveillance of lymph or added back to lymph (lymphocytes)

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25
Q

How many lymph nodes are there around

A

300-400

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26
Q

Where are most of the lymph nodes

A

Neck, thorax, abdomen, pelvis and groin

Relatively few in limbs

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27
Q

How are lymph nodes named

A

Whether they are superficial/deep

Associated structures

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28
Q

Lymph nodes are always situated along most lymph vessels true or false

A

True

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29
Q

How do lymph vessels associate with nodes

A

Vessels divide into a number of afferent branches which penetrate the capsule of the node

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30
Q

What does lymph do in the node

A

Percolates sinuses and collects lymphocytes produced by the node and leaves via one or several efferent vessels

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31
Q

What else do lymph nodes produce that arent lymphocytes

A

Macrophages and plasma cells which are involved in immunosurveillance of lymph

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32
Q

What are lymph nodes not associated with

A

Lymph capillaries and the smallest lymph vessels or the thoracic duct or right lymphatic duct (if present)

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33
Q

The thoracic duct has lymph nodes true or false

A

False

34
Q

What are the first group of nodes into which lymph from a particular organ drains

A

Sentinal lymph node

35
Q

What are other lymphatic organs

A

Spleen, tonsils, thymus

36
Q

Where is the thoracic duct located

A

Thorax between azygos vein and aorta

37
Q

What are the 5 main tributaries of the thoracic duct

A

2 lumbar trunks
1 gastrointestinal trunk (variable)
2 descending intercostal/thoracic trunks

38
Q

Where is the origin of the thoracic duct

A

L2 and often described as being marked by a dilation called the cisterna chyli

39
Q

The cisterna chylis is present in all individuals

A

False only 20%

40
Q

Where does the thoracic duct pass through the diaphragm

A

The aortic hiatus

41
Q

Where does the thoracic duct pass in the thorax

A

Through posterior mediastinum from right to left. It eventually passes posterior to the left IVC, brachiocephalic vein and internal jugular to enter the left jugulosubclavian junction

42
Q

Where does the thoracic duct receive lymph from in the thorax

A

Mediastinal trunks from upper liver, diaphragm, heart and oesophagus
5-6 upper intercostal trunks on either side

43
Q

Where does the thoracic duct receive lymph from in the thoracic trunk

A
Left subclavian trunk (upper limb)
Left jugular (head and neck)
Left bronchomediastinal (upper left thorax and heart)
44
Q

What does the right subclavian, jugular and mediastinul trunks sometimes converge to form

A

Right lymphatic duct (approx 1cm)

45
Q

Where does the right lymphatic duct drain into if it exists

A

Right jugulosubclavian junction

46
Q

If the right lymphatic duct doesnt exist where do the right trunks drain into

A

The adjacent great veins separately i.e. subclavian, internal jugular and IVC

47
Q

What are the three sets of nodes of lymph drainage

A

Axillary, deep cervical and inguinal group

48
Q

Older women have less fatty breasts true or false

A

False

49
Q

What is the resting breast gland like

A
Mainly fibrous (white, radio opaque) and adipose (yellow, radiolucent)
Some ducts but few alveoli (secretory part of gland)
50
Q

What occurs to breast tissue during pregnancy

A

Ducts and alveoli proliferate considerably and secrete during pregnancy and lactation
Fibrous and fatty tissue decreases

51
Q

What occurs to the breast post lactation

A

Glandular tissue involutes and is replaced with fibrous tissue and fat

52
Q

Lymph drainage is implicated in spread of malignancies true or false

A

True

53
Q

Where does 75% of breast lymph drain into

A

Axillary group of nodes which also receives almost all lymph from upper limbs

54
Q

Where does most of the remaining breast lymph drain into

A

Infraclavicular and parasternal nodes
Some intercostal nodes
Also abdominal nodes and across midline

55
Q

Where will breast lymph go if normal lymph channels are blocked

A

Inferior deep cervical nodes

Contralateral breast

56
Q

The superficial and deep plexii of the breast lymph interconnect true or false

A

True

57
Q

What are the two groups of inguinal nodes

A

Superficial and deep

58
Q

Where are the superficial proximal group of inguinal nodes located along

A

Inguinal ligament

59
Q

What do the superficial proximal group of inguinal nodes receive vessels from

A

External genitalia, anal region, skin below level of umbilicus also some from the uterus

60
Q

Which ligament do lymph vessels from the uterus travel with

A

Round ligament

61
Q

Where are the distal group of superficial inguinal nodes

A

Termination of great saphenous vein

62
Q

What do the distal group of superficial inguinal nodes receive vessels from

A

Lower limbs

63
Q

Where are the deep nodes located

A

1-3 deep and medial to femoral vein

64
Q

Where do efferent vessels from superficial and deep inguinal nodes drain into

A

External and common iliac nodes and aortic nodes

65
Q

What do efferents from aortic nodes form

A

Lumbar trunks

66
Q

Nodes in the lower limb are sparse but where are some found

A

In popliteal fossa behind the knee

67
Q

What do lymph vessels which form the intestinal lymph trunk drain

A

Most of the abdominal organs especially the alimentary system

68
Q

What do the intestinal lymph trunk follow

A

Major anterior branches of the abdominal aorta (3 non-paired branches)

69
Q

What are nodes that the lymph vessels of the intestinal lymph trunk collected called

A

Preaortic nodes which can be further classified according to location or artery they are accompanying e.g. superior mesenteric nodes

70
Q

What are lumbar lymph trunks formed from

A

Vessels that follow iliac vessels and sides of the aorta

71
Q

What do lumbar lymph trunk vessels drain

A

Urogenital organs, posterior body wall and lower limbs

72
Q

What are the associated nodes of the lumbar lymph trunks called

A

Lateral aortic or lumbar nodes

73
Q

What occurs as a result of anastamoses between lumbar and intestinal lymph trunks

A

Lymph from pelvic organs may end up draining into intestinal lymph trunks. e.g. lymph from testis is known to pass through both preaortic and lumbar n odes.

74
Q

Where do lower thoracic vessels drain into

A

Descending thoracic lymph trunks that contribute to the formation of the cisterna chyli or origin of l=thoracic duct.

75
Q

Where do the upper thorax vessels drain into

A

Bronchomediastinal lymph trunks and from ther einto the jugulosubclavian junction.
Others drain into the thoracic duct in the thorax

76
Q

What is the lymph drainage of the lungs like

A

Deep plexus of lymph vessels and fairly separate group of superficial subpleural vessels.

77
Q

Where are lymh nodes likely to be seen in the lung

A

At the hilus and along bronchi especially at the branching of the bronchi

78
Q

Where do both superifical and deep pleural lymph vessels ultimately drain into

A

Bronchomediastinal lymph trunks

79
Q

What is the highest part of the thoracic duct as it arches behind the internal jugular

A

C7

80
Q

Where does the thoracic duct enter the jugulo-subclavian junction

A

Posterior to the clavicle